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Abstract

OBJECTIVE:

To estimate longtermsurvival, health, and educational/socialfunctioning in patients with Lymeneuroborreliosis compared with the general population.

DESIGN:

Nationwidepopulationbasedcohortstudy using national registers.

SETTING:

Denmark.

PARTICIPANTS:

All Danish residents diagnosed during 1986-2016 as having Lymeneuroborreliosis (n=2067), defined as a positive Borrelia burgdorferi intrathecal antibody test and a clinical diagnosis of Lyme borreliosis, and a comparison cohort from the general population matched on sex and date of birth (n=20 670).

MAIN OUTCOME MEASURES:

Mortality rate ratios, incidence rate ratios of comorbidities, and differences in educational and social outcomes.

RESULTS:

Mortality among patients with Lymeneuroborreliosis was not higher than in the general population (mortality rate ratio 0.90, 95% confidence interval 0.79 to 1.03). Lymeneuroborreliosispatients had increased risk of haematological (incidence rate ratio 3.07, 2.03 to 4.66) and non-melanoma skin cancers (1.49, 1.18 to 1.88). At diagnosis, Lymeneuroborreliosispatients had slightly higher employment and lower disability pension rates. After five years, patients and comparison cohort members had similar numbers of hospital contacts (difference -0.22, 95% confidence interval -0.45 to 0.02, in-hospital days/year; 0.37, -0.10 to 0.83, outpatient visits/year), employment rates (difference 1.5%, -2.1% to 5.1%), income (difference -1000, -20 000 to 18 000, Danish kroner), days of sick leave (difference -0.3, -3.5 to 3.0, per year), rates of receipt of a disability pension (difference -0.9%, -3.2% to 1.3%), and number of children (difference -0.10, -0.27 to 0.08). More patients were married (difference 4.8%, 2.2% to 7.4%) and had completed high school education (difference 7%, 1% to 12%).

CONCLUSION:

A verified diagnosis of Lymeneuroborreliosis had no substantial effect on longtermsurvival, health, or educational/socialfunctioning. Nevertheless, the diagnosis decreased labour market involvement marginally and was associated with increased risk of haematological and non-melanoma skin cancers.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Proportion of people aged 20-60 years at study inclusion registered as receiving disability pension. Top: Lymeneuroborreliosis (LNB) patients and members of population comparison cohort. Bottom: family members of LNB patients and family members of population comparison cohort

Cumulative incidence of people aged <17 years at study inclusion graduating from high school. Top: Lymeneuroborreliosis (LNB) patients and members of population comparison cohort. Bottom: family members of LNB patients and family members of population comparison cohort

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work other than those listed above; KH has received royalties from Thermo Fisher; no other relationships or activities that could appear to have influenced the submitted work.